Journal of laparoendoscopic & advanced surgical techniques. Part A
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J Laparoendosc Adv Surg Tech A · Sep 2011
Case ReportsThoracoscopic enucleation of esophageal gastrointestinal stromal tumor using prone positioning in a patient with severe chronic obstructive lung disease.
Abstract Chronic obstructive lung disease (COPD) is a high-risk factor for pulmonary complications in esophageal surgery. We reported a case of esophageal gastrointestinal stromal tumor (GIST) in a patient with severe COPD. Upper gastrointestinal endoscopy and computed tomography revealed a 3×2-cm submucosal tumor at the lower esophagus, and positron emission tomography showed a hypermetabolic mass (SUV(max)=5.6). ⋯ Taking the patient's lung function into account, we performed a thoracoscopic enucleation for the esophageal GIST while the patient was in a prone position. The postoperative course was uneventful and no significant change was observed in the patient's respiratory condition. Performing thoracoscopic surgery on COPD patients in a prone position is a good therapeutic alternative for reducing the occurrence of pulmonary complications.
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J Laparoendosc Adv Surg Tech A · Sep 2011
Randomized Controlled Trial Comparative StudyEffect of pressure- versus volume-controlled ventilation on the ventilatory and hemodynamic parameters during laparoscopic appendectomy in children: a prospective, randomized study.
Several ventilatory strategies have been introduced to minimize the respiratory and hemodynamic effects of carbon dioxide pneumoperitoneum during laparoscopic surgery. The purpose of this study was to compare the effects of pressure-controlled ventilation (PCV) with that of volume-controlled ventilation (VCV) on the ventilatory and hemodynamic parameters in children undergoing laparoscopic appendectomy. ⋯ During laparoscopy, mean airway pressure and dynamic compliance were significantly higher during PCV with 5 cm H(2)O PEEP compared with that in VCV with 5 cm H(2)O PEEP. And, as there were no differences in other ventilatory parameters and oxygen saturation, both VCV and PCV can be used safely in children undergoing laparoscopic surgery.
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J Laparoendosc Adv Surg Tech A · Jun 2011
Comparative StudyPerioperative outcome of patients with esophageal atresia and tracheo-esophageal fistula undergoing open versus thoracoscopic surgery.
Thoracoscopic approach for repair of esophageal atresia (EA) and tracheo-esophageal fistula (TEF) has become a standard procedure in many pediatric surgical centers. Thoracoscopic surgery in a newborn is demanding from both the surgeon and the patient. The potential benefits for the newborn are still discussed by neonatologists, pediatric intensive care physicians, and also parents. The aim of our investigation was to clearly define perioperative outcome and complication rates in children undergoing thoracoscopic versus open surgery for EA and TEF repair. ⋯ Thoracoscopic repair of EA with TEF is justified because of a comparable perioperative outcome to open surgery, competitive operating times, decreased trauma to the thoracic cavity, and improved cosmesis despite skeptical considerations. Complication rates are not higher than in children operated on through a thoracotomy. However, a learning curve has to be taken into account and large experience in minimal invasive surgery is mandatory for this procedure. Larger series have to be expected for a more objective evaluation of perioperative as well as long-term outcomes. To our opinion, the thoracoscopic approach appears to be favorable and could be a future standard.
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J Laparoendosc Adv Surg Tech A · Jun 2011
Randomized Controlled Trial Comparative StudyEffectiveness and safety of laparoscopic resection versus open surgery in patients with rectal cancer: a randomized, controlled trial from China.
The long-term survival and safety of laparoscopic surgery in patients with rectal cancer remain unclear. The aim of this trial was to assess the efficacy and safety of laparoscopic surgery for treatment of rectal cancer. ⋯ Laparoscopic surgery for rectal cancer is as safe and effective as open surgery in terms of oncology outcomes. Long-term survival for patients with rectal cancer undergoing laparoscopic surgery were similar to those undergoing conventional open surgery, thus supporting the continued use of laparoscopic surgery in Chinese patients with rectal cancer.
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J Laparoendosc Adv Surg Tech A · May 2011
Totally laparoscopic management of choledochal cyst: Roux-en-Y Jejunojejunostomy and wide hepaticojejunostomy with hilar ductoplasty.
Cyst excision with hepaticojejunostomy is the treatment of choice for choledochal cyst. However, late complications after definitive surgery develop occasionally, including intrahepatic stones and cholangitis, because of bile stasis resulting from anastomotic stricture, intrahepatic bile duct stricture, and remnants of intrahepatic ductal dilatation. In type IV-A choledochal cysts in particular, biliary stricture is frequently observed around the hepatic hilum, and ductoplasty for stricture is necessary. In this article, we present our experiences with totally laparoscopic surgery comprising excision of the extrahepatic bile duct, Roux-en-Y jejunojejunostomy, and wide hepaticojejunostomy combined with hilar ductoplasty for choledochal cyst. ⋯ Laparoscopic surgery comprising excision of the extrahepatic bile duct, Roux-en-Y limb formation, and wide hepaticojejunostomy with hilar ductoplasty appears to be feasible for children with choledochal cyst. When there is a stricture near the confluence of the hepatic ducts, laparoscopic ductoplasty appears to be feasible for the surgeon with an advanced laparoscopic skill set.